Objective
The purpose of this research has two related, but different, objectives. The first objective for the interventions (the treatment plans and outcomes is to help answer this research question:
What approaches, strategies and techniques have demonstrated effectiveness at improving anxiety, depression, distress and disordered eating/eating disorders in Type 1 diabetes?
The second objective for the study relates to the qualitative and mixed methods research that we will find in the literature. For that type of research, we want to pose this research question:
What is the lived experience of people with Type 1 diabetes who have anxiety, depression, diabetes distress and disordered eating/eating disorders; and what are their unmet needs?
Background Rationale
Most people with Type 1 diabetes experience difficulties with their mental health, where having diabetes can feel like an emotional burden. The good news is that there been interventions that have been shown to improve the effectiveness and quality of life for those with Type 1 diabetes. If people with diabetes have difficulties, but improve their mental health, they may have better control over blood sugar, known as glycemic control (A1c). Having positive mental health may make it easier to take care of the challenges that self-management brings, such as eating healthy, getting physical activity and taking insulin. In this proposal, we will be conducting a thorough review, or a "systematic review" on these four mental health conditions that can affect people with Type 1 diabetes: depression, diabetes distress, anxiety and eating disorders/disordered eating. This systematic review will identify the interventions that have been done by researchers to improve these conditions, and evaluate the effectiveness of the treatment to improve mental health for people with Type 1 diabetes.
Description of Project
Most people with Type 1 diabetes experience difficulties with their mental health, where having diabetes can feel like an emotional burden. The good news is that there been interventions that have been shown to improve the effectiveness and quality of life for those with Type 1 diabetes. If people with diabetes have difficulties, but improve their mental health, they may have better control over blood sugar, known as glycemic control (A1c). Having positive mental health may make it easier to take care of the challenges that self-management brings, such as eating healthy, getting physical activity and taking insulin. In this proposal, we will be conducting a thorough review, or a "systematic review" on these four mental health conditions that can affect people with Type 1 diabetes: depression, diabetes distress, anxiety and eating disorders/disordered eating. This systematic review will identify the interventions that have been done by researchers to improve these conditions, and evaluate the effectiveness of the treatment to improve mental health for people with Type 1 diabetes.
For healthcare providers to find these studies that have been conducted to improve the mental health in people with diabetes is sometimes a problem, because of the large number of studies, and the fact that these studies are not available in one place for quick review. If a healthcare provider wants to know what they to do to help a person who is struggling with diabetes distress, for instance, they would need to get on a computer and search a medical database (such as www.pubmed.gov) to try to find articles.
It's difficult to know exactly what words to put into the database so that they can find the most up-to-date treatment and information. However, if a systematic review is completed, the healthcare provider can review all the studies that have been done for depression in one place and choose the one that is most appropriate for their patient. Also, a systematic review helps researchers know what kinds of studies have been done, so that either that can do a similar study (replicate) or build upon the studies that have already been done. It helps to advance the field of science in these types of mental health and behavior interventions because the research is available in one place, and researchers can determine what type of future research needs to be completed.
Completing a systematic review takes a lot of time and researchers who are experts in doing reviews and in diabetes self-management and mental health. It is a rigorous process that involves a few steps. First, a librarian from a medical college will choose articles from tens of thousands of articles that meet what we call "inclusion criteria," or search terms that help the researchers to be more specific in their search. Then, those articles are reviewed by two researchers on the team, who agree that the article should be included in the review based on the inclusion criteria. The full article is pulled, read, and certain information about that article is placed into a table (for example, the number of people in the study, the purpose of the study, the type of information, and the results of the study). This systematic review will then be published so that healthcare providers and researchers can use the information to help people with diabetes. People with diabetes could also access the review by asking their health care professional or by looking up "systematic review" and "psychosocial" and "Type 1" on the medical database. It's a great way to know what is new in diabetes mental health care!
Anticipated Outcome
The outcome will be a systematic review that can be published for review in journal articles, but also on Type 1 diabetes organization's websites, such as the American Diabetes Association and the Juvenile Diabetes Research Federation. The publication will have tables that will be filled with the information from the studies that have been included in the systematic review. The tables will include items such as these: (1) the Stage of Intervention; (2) Theoretical or Conceptual Model; (3) Sites and/or Countries; (4) Population and Sample Size; (5) Type of Intervention; (6) Activities/Programs Involved; (7) Surveys or Measures Used; (8) Effect/Outcome of the Intervention; and (9) Future Research Recommended for the Field.
We will register the protocol for the review on PROSPERO (PROSPERO (york.ac.uk), an international database of systematic reviews that will provide a complete detailed description of the process by which the review will be completed. That way, researchers will know where to find the most recent reviews.
Relevance to T1D
Most people with diabetes have some type of psychological difficulty, because having diabetes can be a burden. It takes a toll on not only physical, but mental health, as well. This review will help researchers know what to study to help further improve the lives of people with Type 1 diabetes, and help to relieve some of the pressures that diabetes can bring. It will also help health care professionals know what the most recent treatments and effective studies have been done so they can provide the best, personalized treatment for people with Type 1 diabetes.